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SOURCE: Wall Street Journal

This article is reprinted by permission from CareerJournal.com

Shortage of Skilled Health-Care Workers Requires New Recruitment Solutions
By Julie Bennett

The 1,000 nurses who went on strike on Oct. 23 against Long Beach Memorial Medical Center in California reflect a larger, national problem just when the population is aging and health-care needs are increasing, the country has a shortage of health-care workers. And many employees in the industry are so dissatisfied that they're driving newcomers away.

This paradox affects all levels of recruitment and retention. At top executive search firms, health-care recruitment is now bringing in a greater percentage of the revenue. Buster Houchins, managing partner of the life-sciences practice of executive search firm Christian and Timbers' Washington office, says: "Our business has definitely increased and now represents 15% of total company revenues." But searches, he adds, are getting harder.

Unfilled Positions
Doctors with in-demand specialties, like cardiology, oncology and neurosurgery, are paid huge sign-on bonuses and relocation' fees to move. And nurses are in such short supply - the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in Oakbrook Terrace, Ill., says there are now 126,000 unfilled nursing positions nationwide ﷓that hospitals are increasing the workloads of the nurses they do have, often with disastrous results.

"One of the biggest challenges facing health-care providers is the shortage of skilled workers," says Chris Forman, senior director of
human-capital solutions for AIRS, a recruitment, sourcing and technology training firm in Wilder, Vt. The online AIRS Directory lists 299 job boards actively recruiting health-care workers, and Neal Fenster, president of Enterprise Medical Services in St Louis and former president of the National Association of Physician Recruiters, says the country has about 750 organizations that recruit doctors.
But candidates are elusive. Roberta Borer, senior vice president of Bristol Associates in Los Angeles, who recruits clinical and administrative managers, says some searches can take as long as a year. Certain positions are so specialized, "there are maybe 100 people in the country qualified to fill them," she says.

The serious nature of the nursing shortage was underscored last month when the journal of the American Medical Association published a research report linking a nurse's workload directly to patient deaths. When nurses in post-operative wards take care of more than four patients at a time (the average is six), the chances of life-threatening problems increase
The US. health-care industry is facing a severe shortage of
dramatically. When nurses handled eight patients instead of four, for example, there were 18.2 extra deaths per 1,000 patients with complications.

There's also an economic impact, says Marc Drizin, an employee-loyalty specialist with market-research firm Walker Information in Indianapolis. Because hospitals cant fill shifts, they require nurses to work overtime; according to JCAHO, the average nurse works an extra 8.5 weeks each year. With dissatisfaction already high, nursing turnover in U.S. hospitals is 21% a year and rising.

According to Mr. Drizin, it costs a hospital 1.5 times a nurse's salary to hire and train a replacement. "If you have a hospital with 400 nurses who earn $40,000 each and have to replace 84 of them, the hospital is spending about $5 million a year, or $18,000 a day, just on turnover."

A more cost-effective approach is keeping the nurses you have. But when Walker Information surveyed the satisfaction levels of nurses, the results were dismal. Nurses go into the profession, Mr. Drizin says, not for the money, but for the social good they can do. And almost all gave the patient-contact element of their jobs a high rating. But less than half said their employers showed "care and concern" for them and over 40% said they would not recommend their hospital to a friend as a good place to work. "Even worse," he says, "an American Nurses Association survey says 55% of nurses would not recommend that their children or grandchildren enter the profession."
A JCAHO report, "Health skilled workers. Nursing turnover is 21 % a year and rising.

Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis," says that attitude is having an impact. The average age of a registered nurse today is 43.3; by 2010, it will be 50, and enrollment in nurses training programs fell for six consecutive years (1996﷓2001). The report suggests improving nurses' work environment by reducing workloads, replacing onerous paperwork with technology, reducing injuries by adding ergonomic devices to lift patients, penalizing doctors who yell at them and offering in-service training.

The same week the Long Beach nurses formed a picket line, union nurses in 17 other California hospitals ratified a contract with their employer, health-care conglomerate Kaiser Permanente, that included wage increases of 26.5% over four years, plus a ban on all mandatory overtime shifts. Terry Lightfoot, a spokesperson for Kaiser headquarters in Oakland, Calif, says his company instituted many of the reforms outlined in the JCAHO report two years ago, and that over the past year, nurse retention has increased 500%.

Another byproduct of nurse dissatisfaction is the dearth of nurse managers. Young women with leadership potential tend to choose business or law over nursing, says Ms. Borer of Bristol Associates. And because nursing is primarily a female profession (only 6% are male), when a nurse is qualified to fill a management position, she's reluctant to relocate. "One of the hardest positions to fill now," Ms. Borer says, "is a director of surgical services. Once we find a
candidate, we then have to find a job for her trailing spouse."

Recruiters of nurse managers and of top health-care executives follow the industry practice and charge clients about one-third of a candidate's first-year salary. But physician recruiters charge a flat fee, of $15,000 to $30,000 for each search. That seems only fair because salaries vary dramatically according to specialty and area of the country. Mr. Fenster, of Enterprise Medical Services, says he recently completed two searches for cardiologists - one at a guaranteed second-year salary of $1 million and a second for $130,000. Rural hospitals, he says, have to pay more in salaries and relocation packages than hospitals in desirable cities like Washington.

Getting doctors to move has become more difficult since Sept. 11, says Eva Page of Eva Page & Associates Inc., a retained and contingency firm specializing in physician recruiting, in Bellingham, Wash., because people today want to stay close to their families.
Dr. Ron Workman, a resident in the department of radiology and nuclear medicine at Duke University in Durham, N.C., launched the Web site moonlightingdoctor.com in 2001 to match young doctors in residency (training) programs with medical centers that are short of staff. "There are plenty of hospitals that need additional coverage, especially in the emergency room and walk-in clinics," Dr. Workman says. He has 500 doctors registered on the site who earn $100 to $150 an hour for their part-time work.

Doctors, too, are disillusioned with the health-care industry
and its challenges - reduced payments from Medicare and insurance providers, increased costs of malpractice insurance and heavier workloads. "Many are so fed up they think they'd rather run a hospital instead," says David Mead-Fox, senior client partner for health care in recruitment company Korn Ferry's Boston office. But health care has become so complex that physicians who have spent their careers in clinics and operating rooms do not usually make good administrators.

Health-Care Administrators
Mr. Mead-Fox says he has widened his searches for healthcare administrators and recently convinced the dean of a medical school to become the CEO of a prominent children's hospital.
As with nurse managers, the pool of senior managers, such as prospective hospital CEOs and medical school deans, is very limited, Mr. Mead-Fox says.

But younger physicians who are keen to lead still have time to grow into those positions, he says, by developing leadership skills and pursuing MBAs. In fact, he predicts the shortage at the very top of the health-care industry should end in five to seven years. At the same time, federal and local programs designed to bring more people into nursing, like low-cost education loans, should begin to turn around that shortage as well. Nevertheless, Mr. Mead-Fox says, "Health care is like no other industry. It's highly regulated, requires a tremendous amount of training and deals with life and death every day. There will always be a shortage of workers willing to enter the field."

This article is reprinted by permission from CareerJournal.com, (c) 2003 Dow Jones & Co. Inc. All rights reserved.